I'm a Professor of Biomedical Engineering, Computer Science, and Biostatistics in the Institute of Genetic Medicine at Johns Hopkins University's School of Medicine. From 2005-2011 I was the Horvitz Professor of Computer Science and Director of the Center for Bioinformatics and Computational Biology at the University of Maryland, College Park. Before joining UMD, I was at The Institute for Genomic Research, where I sequenced the genomes of many bacteria, including those used in the 2001 anthrax attacks. At TIGR I was part of the Human Genome Project and the co-founder of the influenza virus sequencing project (which is when I first learned of the anti-vaccine movement). My research group develops software for DNA sequence analysis, and our (free) software is used by scientific laboratories around the globe. I did my B.A. and M.S. at Yale University, and my Ph.D. at Harvard University, and I have published over 200 scientific papers. Follow me on Facebook or Twitter (@stevensalzberg1), or just subscribe to my alternate blog, http://genome.fieldofscience.com.

Naturopathic shenanigans in the Maryland legislature

Quacks never give up. In their never-ending quest to make money from bogus treatments, they try all kinds of strategies to convince people that what they’re selling really, really works, despite the evidence to the contrary.

One strategy is creating a legal licensing system. If the government licenses your profession, it must be legitimate, right? Legislators wouldn’t approve a licensing system for nonsense, would they? Of course not!

So it’s strange that the Maryland legislature is considering a bill in its upcoming session to allow naturopaths to practice medicine in the state of Maryland.

Some of you might be wondering, what the heck is a naturopath? As Peter Lipson explained recently in his Forbes column, naturopaths are little more than fake doctors, whose practices are a modern-day version of folk medicine. When naturopaths got licensed in Minnesota, PZ Myers suggested they be called “witch doctors.” Too harsh? One thing is clear, though: naturopaths are trying to get licensed in multiple states (Lipson described their efforts in Michigan) as a route towards legitimacy.

There’s an easy way to become legitimate: practice science-based medicine. This would be awfully difficult for naturopaths, whose practices include homeopathy, colloidal silver treatments, and chelation therapy, to name but a few.

When the naturopaths tried this in Massachusetts 10 years ago, my colleague Kimball Atwood put together detailed testimony describing many of the unscientific and downright dangerous practices of naturopaths. I encourage anyone to read his full testimony or his series of blog articles. Here, though, is a brief sample of the erroneous claims made by naturopaths, courtesy of Dr. Atwood:

“… that hydrogen peroxide dissolved in a bath can provide vital oxygen through the skin of a patient suffering from an acute asthma attack [5];

[Aside: I have no idea what it means to "administer electromagnetic energy"; perhaps you simply shine a light on the patient? I suspect the legislators who are sponsoring this bill haven't a clue either.]

“One technique is to lower your body temperature, with a cold bath for example, as much as possible without inducing shivering as soon as possible after a stroke has occurred, or is suspected to have occured…. Another hydrotherapy technique with a similar rationale is to soak the feet in a hot foot bath, as soon as possible after the stroke has occurred, while applying a cold compress to the neck, face and scalp. If this technique can be applied as a stroke is happening, it may even abort the stroke.”

Again, quoting Dr. Atwood: “All strokes are potentially life-threatening, and are considered to be medical emergencies that require prompt and expert evaluation and supportive care. The treatments described above will do nothing to improve the outcomes of strokes, but are certain to delay competent diagnosis and treatment.

Most disturbing, perhaps, is that the new Maryland bill would require physicians to violate medical ethics. The AMA code of ethics states that

“It is unethical to engage in or to aid and abet in treatment which has no scientific basis and is dangerous, is calculated to deceive the patient by giving false hope, or which may cause the patient to delay in seeking proper care.”

By adding a naturopath to the Maryland State Board of Physicians, and by requiring them to license naturopaths to practice medicine, the legislature is forcing physicians to act unethically.

So if you live in Maryland, take a few minutes and write to your state representative telling him or her not to support this quack bill. Heck, contact them even if you don’t live in Maryland, and tell them you were thinking of moving but now you want to move to Virginia instead.

[Update, March 22: both the House and Senate committees in Maryland defeated the bill, in a surprise victory for reason and science. Good work!]

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This author clearly has no idea what he’s talking about. Naturopaths are legitimate healthcare professionals who place scientific emphasize in the treatment of patients. As one medical doctor mentioned in a recent conference I attended; ” We’d like to think we practice science-based medicine, but less than 50% of what we practice is science-based.” The fact of the matter is no-one is practicing hard-core science-based medicine where results from such research is conclusive enough to alter how doctors practice. The modern naturopathic doctors I know practice naturopathic, inclusive medicine based on scientific principles, like I do. And they (we) are very good at it.

One study showed that over half of surveyed “degreed” naturopaths did not recognize that a fever in a 2-week-old neonate required emergency care.

A large study [Downey 2010] in Washington State found:

“Compared with children who received all health care from conventional providers, those who saw both conventional and CAM providers had significantly lower rates of all four vaccinations, and rates among children who received care exclusively from CAM providers were lower still.”

“Naturopathic care [is] a significant predictor of reduced rates of all vaccinations.”

Hey Geo. Went to UB with you in their ND program around 2000-2002: a program I ceased before graduating due to naturopathy’s nonsensical contents — like homeopathy, vitalism, and supernaturalism etc. all quite absurdly labeled “science-based”.

How are things at NYU’s Lagone?

I’m completely in agreement with SS and I disagree with your emphasis that ‘the naturopathic’ as scientific, scientific, scientific — obviously.

I know you all call it “science”: like UB claiming naturopathy is within a Division of Health Sciences. But, if naturopathy is TRULY so scientific, then why does it contain homeopathy at all, a completely bogus therapeutic that is mandatory to get an ND degree and labeled quite absurdly a clinical science on your board exams, the NPLEX?

Why was I able to post at Naturocrit a video by a newly minted NCNM ND who practices the bogus diagnostics known as applied kinesiology and dried blood cell analysis? Like with UB, NCNM claims that naturopathy’s contents pass rigorous scientific scrutiny.

But then, as I asked before, why is AK and DBCA being practiced diagnostically at all when both of which are akin to reading tea leaves, in the absolute dark, in rough seas?

Hi Rob, I wish I can say I remember you from UB but I don’t. Maybe If I’d see you I would. AK is not part of the ND curriculum as you know. Homeopathy is. UB as is naturopathic medicine in general has come a long way in applying scientific principles to naturopathic treatments for over a decade. By the way, naturopathic doctors are trained to understand their limitations and refer accordingly – unlike non-licensed “natural healers.” Homeopathy, although lacking in scientific rigor seems to help many people with numerous ailments. I do not practice much homeopathy but I have seen it work on animals and babies where one would discount any placebo effect. Let’s not deny that most of the scientific research as we know it, is about 80% of the times funded by pharma industries and that most of those studies funded by pharma industries (about 50%) have positive outcomes compared to studies funded by the government. Naturopathic medicine has flaws like all of medicine. I have had the privilege of working closely with MD’s for close to 10 years now and the unintentional mismanagement and unscientific approaches towards patients happens often. You may also remember one of the principles being prevention of disease which would lower healthcare cost even more. Up and onward with licensing of Naturopathic medicine in all 50 states.

Politely, I must say ‘I think you don’t know what I know’ about my ND school experience, specifically. I can’t speak for others, but I have my AK notes from ND school and Goodheart’s book was required for the course. I’m holding handouts given to me such as bogus “applied kinesiology reflexes” indicating muscles and what organ their weakness supposedly indicates a problem with, bogus hand and feet reflexology organ and muscle mappings, bogus skull mappings of correlating major muscle groups.

And regarding homeopathy — that grandest of parlor tricks — appearing to work: there are other reasons besides placebo that you are not accounting for. There is, for instance, confirmation bias and regression to the mean. It is a simple fact that the better the science done on homeopathy, then ANY effect evaporates into the grey noise of background nonspecific treatment artifact. Yet, NYU’s page explaining naturopathy calls it a branch of medical science, and you’ve acknowledged that homeopathy is within naturopathy. But, science subset naturopathy subset homeopathy is quite patently false. It doesn’t matter who you then point fingers at in deflection.

Your repeated defense of ‘everybody else is just as _____, so stop picking on us’ (tu quoque) does not dismiss legitimate criticism of naturopathy. The points made against naturopathy stand or fall on their own merits.

The last thing I will say is that it seems like you are very much out of touch with naturopathic medicine at this point and apparently still holding some ill feelings from past experiences. Naturopathic medicine continues to be a branch of medicine that uses science-based approach in the integrative treatment of many illnesses. It focuses largely on the prevention of disease and it would significantly lower health care cost (probably the biggest fiscal problem the US faces at this time.) It would be incumbent for legislators to license naturopathic medicine in Maryland along with the rest of unlicensed states. I encourage you to rethink your position, redirect your sentiment and support naturopathic licensure in all 50 states. Best Rob. By the way, I think I know remember you.

Thank you for your comments. However, as a current student I would like to offer my input into this conversation regarding what is being taught at BU. AK is NOT taught in the Bastyr Curriculum and it should be noted that “weekend workshops” attended by some students OUTSIDE of BASTYR are frequently TAUGHT BY an MD. No Goodheart required texts at BU presently, but I can’t speak for BU Y2k; your experience is your own.

I also find it somewhat hilarious that Iris Bell’s presentations have slipped by so many. She is one of the top researchers in homeopathy and AGAIN is an MD. She also is a PhD. If you are interested in her research and looking at the evidence I would consider viewing her ITunes University presentation.

I also find it even MORE hilarious that JUST 4 DAYS ago at ACC’s national conference an MD authored presentation broke headlines on chelation and MI. http://www.medpagetoday.com/MeetingCoverage/ACC/37797

As for DBCA, this is nowhere to be found in our curriculum and know MANY NDs who openly reject this method.

I am also curious how many MDs treating Crohn’s Dz are still prescribing Mesalamine despite Hanauer’s 2004 study on the subject? Or maybe Dr. Beatrice Goloumb’s Ann Int Med. 2010 paper was missed too? What I am hearing from some of the comments and this article is that as Doctors you care about patients and want the best treatments for them…AND this MEME is shared by ALL NDs!

Licensing, registration, or certifying any form of naturopathy also grants a license to milk money from the government. PPACA (ObamaCare) through the Harkin amendment mandates full reimbursement for services by any state-regulated health practitioners.

It looks like naturopaths are actually anti-science. The 2012 edition of the naturopaths’ main textbook by Joseph Pizzorno (founder of Bastyr, the foremost naturopath school) has new chapter that teaches four humors theory, “diagnosis” and “treatment.” Yes, this is none other than the ancient Greek belief system that held back the development of safe and effective healthcare for centuries and even led to the death of George Washington by repeated bleedings. I’d say that naturopathy is not only anti-scientific, but it is headed straight for the Dark Ages.

Hi Linda. I attend Bastyr University and while Dr. Pizzorno’s book is in our bookstore, I can assure you it is not considered a “main textbook” in our curriculum, nor is it a required text in any of our classes. As a matter of fact, Dr. Pizzorno is no longer affiliated with Bastyr at all. To call naturopathic doctors/physicians “anti-science” is just false and shows your lack of knowledge about our curriculum and training. Perhaps you’ve had too many experiences with laypeople who call themselves naturopaths without any formal training from an accredited institution. I would also ask that you not base your opinion of an entire profession on one man (or a few people) who shares the title.

For one general overview of scientific analysis of naturopathy from a few perspectives from the past few years, I recommend the just released e-book anthology by the James Randi Educational Foundation and the folks at Science Based Medicine:

Steven Salzberg, you’re a fraud. This article is embarrassing and I’m surprised Forbes would allow their name associated with such ignorant and arrogant views.

Clearly this contributor hasn’t done the homework. ND’s (those who graduate from 8 of the US and Canadian medical schools) are not quacks. They use the same code of ethics as MD’s, obtain doctorate degrees, pass board exams and are fully qualified primary care providers. But where they stand apart is that while ‘doing no harm’ (the oath every physician is held to) they also provide compassionate care while steering away from the allopathic, cut it, drug it or burn it model. If MD’s spent more time with their patients, took the time to explain the science, and didn’t practice pure allopathy, the ND industry wouldn’t be growing at the pace it is. Clearly there’s a demand for this kind of medical care.

Steven Salzberg, you’re a fraud. But more of an alarmist ‘FoxNews’ kind. Between the Rush Limbaugh and Glen Beck shows you were able to crank out some horrible, uninformed and whiny garbage and I can’t believe a reputable organization like Forbes allowed this to be published with their name associated with it.

I hope that on you path to becoming a more educated human you see a ND or at least do more work to better understand the naturopathic philosophies.

Kala, quacks sell and promote snake oil. NDs sell and promote colloidal silver. That includes those who have degrees from the ND schools you speak of. According to my definition that makes them quacks.

The ND industry is growing because it is being aggressively and fraudulently marketed, but are many people really looking for the services of NDs? Do many seek them out? Based on my experience in Vermont, I seriously doubt it. According to testimony given to VT legislators by ND rep, Lorilee Schoenbeck, 95% of the NDs licensed in VT are taking new customers at a time when many MDs are not. http://rosemary-jacobs.blogspot.com/2012/05/vermont-bill-s209-lorilee-schoenbeck-nd.htm

While NDs in VT are licensed as primary care physicians and covered by insurance, many have other sources of income besides their practices. If people really wanted their services, they wouldn’t have time for second jobs.

MDs value and have been traditionally taught evidence-based medicine in their schools. NDs value and are taught a belief-based system of medicine in their 4-year accredited schools which maintains that Nature is benign and caring and provides us with the remedies we need to optimize health.

NDs not only believe that specific “remedies” and “therapies” are safe and beneficial when there is no objective evidence to support the belief but also when there is an overwhelming amount of objective evidence demonstrating that the opposite is true. That is why NDs licensed as physicians are truly dangerous and terrify me. http://rosemaryjacobs.com/naturopaths.html http://rosemary-jacobs.blogspot.com

This author clearly has no idea what he is writing about. There is a difference between naturopathic physicians that are trained in four year medical schools and the “holistic practioners” that get a certificate online after a weekend webinar. While some naturopathic physicians prescribe the things mentioned in this article, the core of naturopathic medicine is based around working with an individual’s lifestyle. It is very obvious to me that this author has never been to see a doctor of naturopathic medicine (NMD or ND). I think that before anymore is said on the matter, Ms. Rosa and Mr. Salzberg and anyone who has an interested in naturopathic medicine should go and visit one. The importance of getting licensed is to allow all people access to this exceptional medicine.

Wow, this might be one of the most non-academic discussions I have come across. I have yet to read any “science” in this article, rather, more emotion and egotistical nonsense.

First of all, it’s easy to raise one’s opinions and non-sense without experience. I would LOVE to all those opposed of naturopathic medicine to attend an American Association of Naturopathic Physicians conference and actually experience the knowledge and expertise that these physicians bring to the ART of medicine. Yes, I say ART of medicine, because I think it is almost entirely lost in our nation – a nation that ranks #40 in the Bloomberg report’s list of worlds healthiest nations. Yes 40. Evidence-based medicine (which is also taught in ND curriculums just like MD and DO schools) clearly doesn’t have all the answers to tackle our nation’s healthcare problems, considering we are lower in health and patient outcomes than some third world countries. And on that note of evidence-based medicine, let’s talk about that actually. Not all trials and their results even get published, so evidence-based medicine isn’t really evidence-based. It’s imperfect. Sure, it’s very important, but it’s not the magic pill that’s clearly solving our nation’s healthcare crisis. There must be something more to the puzzle.

I challenge you to remove your egos and start dialoguing instead of attacking. Heck, you might even learn something. Why are we seeing even more MDs, DO, and other health professionals going BACK to medical school to pursue ND degrees? Because they have observed the power of Naturopathic Medicine, have seen its results either directly or indirectly, and find it valuable enough to go back through a rigorous curriculum to practice a form of medicine that’s sole purpose is to get to the root cause of illness and disease.

I CHALLENGE you to attend an integrative medicine or naturopathic medicine conference this year. You might be surprised what you learn and start seeing physicians practicing this form of medicine in a different light.

And one more note…MANY physicians in ND school are there by CHOICE. They could have gone to MD or DO school (many kicked ass on the MCATS), but they CHOSE this path because they wanted to be the change they want to see in medicine. Coming from a country that’s #40…I don’t think you can argue with that.

Reading things like this article and many of your comments is really hurtful, both to me personally and the profession I will be entering in a little over a year. You all need to do a little more research before you post information like this. I am a third year ND student at Bastyr University with a B.S. in Chemistry and most of the things written here are extremely outdated (probably by 100 years or so) or just completely wrong. We are taught a very science based curriculum by PhD’s, ND’s and MD’s, our curriculum is VERY similar to that of MD’s, with the main differences in our medicine being the philosophy and the interventions we use. We believe in treating the cause, rather than the symptoms of disease. We focus on prevention and education and treating the whole person. I feel like these things are lacking in allopathic medicine. I have no idea what this whole colloidal silver treatment thing is and not one of my classmates is dumb enough to put someone having a stroke in an ice bath. We would send them to the ER. We are not good at emergency medicine, we know when to refer to MD’s and hospitals when necessary. What we are good at is treatment of chronic diseases like diabetes and cardiovascular disease and complimentary care, especially when it comes to cancer treatments like chemo and radiation. We learn counseling and physical medicine. We learn how to use diet to manage diseases. (If diet and lifestyle changes are such common sense, then why is America one of the most sick, overweight countries in the world?) Yes, we use herbs in our medicine. There is A LOT of research published on herbs in peer-reviewed journals (do a pub-med search). We also have the ability to use pharmaceuticals in states in which we are licensed. We know that when someone has a raging bacterial infection, antibiotics are often the best option. We can give vaccines, and do pretty much anything an MD does. When there is a shortage of primary care physicians, and we are willing to help fill that gap, it is frustrating that we are finding so much resistance when it comes to licensing. I think we owe a lot of that resistance to the pharmaceutical companies and the American Medical Association, both of whom will be losing out on money if we are. We are not in this for the money, if we were, we would have gone to MD medical school. Many of us are studying naturopathic medicine because we saw how corrupt and ineffective our medical system is and we wound a medicine that we believe can really help people. We don’t want licensing to fool you all into using our witch doctory, we want it because we want to help as many people as we can.

I find it interesting that all of the collapsed comments are pro-ND, and that anti-ND replies to the pro-ND collapsed comments are NOT collapsed and can be easily seen. Coincidence…? I think not. Way to go, Forbes.

As an ND (Doctor of Naturopathic Medicine) student at Bastyr, I’d like to thank you for mentioning us! Although I haven’t learned about applied kinesiology, I have learned about human anatomy in a year of gross anatomy consisting of human cadaver dissection, living anatomy consisting of palpation of anatomical landmarks, and many hours of human anatomy lecture (with Moore and Dalley’s Clinically Oriented Anatomy and Netter’s Atlas of Human Anatomy). It’s been wonderful and challenging to be in this medical school and get the opportunity to put the anatomy and physiology that I’ve learned together in my physical clinical diagnosis course where I learn physical exam techniques to aid in my future diagnosis of illnesses and injuries that my patients may present with (such as appendicitis and fractures). Although I haven’t heard of the four humor’s method of diagnosis outside of one philosophy class that covered the history of medicine and origins of modern medical practice, my favorite class thus far is pathology. I enjoy our textbook (Robins and Cotran’s Pathologic Basis of Disease) and am amazed by how complicated and yet identifiable the pathogenesis of human illness is. Particularly from the perspective of a student of such a rigorous four-year doctoral program, I value the importance of legislation recognizing and regulating the medical practice of naturopathic doctors. As a consumer and citizen, this article and many of these comments are concerning for their gross misstatements and unfortunate misunderstanding of naturopathic medicine, medicine in general, and the therapeutic techniques used by healthcare practitioners. These seem to be sadly fueled by hate and willful ignorance rather than an openness and educated understanding that could lead to an honest and useful dialogue about modern healthcare and legislation.

I’m a student of Naturopathy Medicine at Bastyr University. Typically I don’t reply to this type of discussion as they always seems to get nasty fast and rarely does the discussion yield productive results. But I’ve been asked to, so here I am. The most important piece missing from this discussion is what licensure means and why it’s important. Licensure increases our liability and helps protect patients. It makes us practice safe, regulated medicine. It also standardizes the definition of naturopathy. As of now, any Tom, Dick or Harry can claim to be a naturopathic physician in a unlicensed state. That’s really confusing to health care consumers. Some of the treatments I’ve seen unlicensed naturopaths offer (a couple of which you mentioned) are frightening. Licensure insures those claiming to be naturopaths are thoroughly educated. There is clearly a market for naturopathy. Licensure makes the marketplace safe, transparent, and regulated.

I’m not a brutal person. And I’m not a mean person. But, I do have quite an exquisite BRAIN.

Over the years, in public discourse, naturopaths have been quite EVASIVE aka SILENT. Almost NINJA!!! Glad to hear from you all. It furthers the litigation.

What you ND / NMD people don’t seem to get is that there are standards that filter what science is and isn’t. You can’t decide for yourselves what those boundaries are.

Science, simply speaking, isn’t whatever you desire it to be. I have indexed national science standards to suport that fact. And I particularly like how the Dover school board fiasco failed in terms of expanding the scientific to include the nonscientific.

Now, when NPLEX tells me that homeopathy is science, well… what I think about is the ENTIRE preponderance of lack-of-evidence that points to homeopathy’s absurdity scientifically.

And I WENT TO ND SCHOOL AND LISTENED TO THEIR BULLSH@T.

Perhaps the only difference between me and usual ND students is that I CONTINUED THINKING [please keep thinking].

That huge mass of ‘lack-of-evidence’ is as movable as a pile of rationality in the face of the demands of stupidity. Can stupidity move rationality?

Only in the the dreams of the nut-cases.

Perhaps, yes, you can move it, as long as you become stupid / irrational and admit that moving something is equal to accomplishing NOTHING / stasis.

You Bastyr people, particularly, perhaps, may admit this, if you have any iota of intellectaual capacity:

a) Bastyr has a marketing slogan of ‘science subset supernatural / nonscience’ as you state, and I quote:

“[your bullshit artist ND Pizzorno at http://www.bastyr.edu/about/about-our-university/history-heritage ] a resurgence for the naturopathic field by building the school on a science-based foundation.”

b) but, why is homeopathy therein? Why is craniosacral therapy?

You built what? Science subset nonscience. I will continue to fight. Perhaps in all this I may even get damages.

I’m not sure which school you went to, but most of us at Bastyr are there because of the mostly science based curriculum. I don’t want to say anything negative about the other schools because I haven’t been there, but we do have a very strong science foundation at ours. Almost everything we are taught is backed by the PEER REVIEWED studies that people seem to value so much. We are also taught how to interpret these studies and look for weaknesses in them, which many of them have. If you are as smart as you think you are, RC, you will know that many of those peer reviewed studies that the medical community heavily relies on are heavily biased and there are a lot of very weak studies out there. I read an article once that said something like less than 50% of interventions used by MD’s actually have strong positive research to back them up? So, how science based are they? Yes, not everything we are taught has this type of research to back it up, but if that research isn’t there and it’s in our curriculum, it’s there because it has been used for hundreds or even thousands of years (which says something in itself, no?) or it’s a treatment that our professors have seen work rather consistently first hand. I personally do not plan on using much homeopathy in my practice, but I have seen and heard stories of it doing pretty miraculous things. If it is only placebo effect, who cares. If it works, it works. Just because you cannot explain it does not mean it doesn’t work. And you basically calling us sheep blindly following this curriculum couldn’t be more wrong. I have never been around more independent thinkers than I have been around at Bastyr. We definitely aren’t afraid to question things. I think that’s one of the things that led us into this field to begin with.

Well said. I would like to add that just because science doesn’t have the tools to explain something like homeopathy, doesn’t mean that homeopathy is lacking. It is the current methods in science that are lacking. Now don’t mistake this as me being “unscientific.” I just accept that we are human and we have limits to our senses and perceptions. I guess if science has ALL the answers currently, then we should all just pack up and quit. “We” being those of us with curiosity and wonder about the world. Small minds will always strike out at things they do not understand. The world is flat and Earth is at the center of the universe. History will continue to repeat itself… how unfortunate that we are still playing this game.